Primary care physician versus urologist: how does their medical management of LUTS associated with BPH differ?

Medical and surgical therapies for benign prostatic hyperplasia (BPH) are based largely on the results from adherence to the 2003 American Urological Association Guidelines. However, with the emergenceof medical therapies as first-line treatment and the expansion of medical therapy for lower urinary tract symptoms (LUTS) into the primary care office, the evaluation and management of men presenting with urinary symptoms can vary depending on provider type. This review explains the basis for BPH medical management in primary care with the review of three key studies. In addition, this review utilizes the data provided by the first longitudinal, observational BPH registry to evaluate patient outcomes and practice patterns in both urologist and primary care offices. From these data, we can conclude that men seeing urologists were more likely to be on medical therapy than men seeing primary care physicians (PCPs), who more often utilized watchful waiting. Urologists also were more likely to prescribe 5-alpha-reductase inhibitors (5ARIs), combination therapy with an alpha-blocker and 5ARI, and anticholinergic therapy. In contrast, the use of nonselective alpha-blockerswas appreciably greater among men seeing PCPs than men seeing urologists.